What the Supreme Court Ruling on the Affordable Care Act Means to Missouri

By Brian Colby on July 5, 2012Director of Outreach and CommunicationsMissouri Health Advocacy Alliance

The Supreme Court ruling last Thursday was a thrilling day that will go down in history. Thousands of people gathered at the front steps of the court and millions more huddled around televisions, watching with great anticipation. The ruling — letting the individual mandate stand and more importantly, the consumer protections that make the mandate necessary — will provide peace of mind to millions of American families.

The ruling will allow for the law to move forward to create a new world where private insurance coverage seeks to cover everybody without regard to health status or gender. Pre-existing condition exclusions and discrimination against women in the insurance marketplace have a chance to be a thing of the past. Young adults entering the workforce where employment options often don’t provide insurance benefits now can stay on their parents’ plan. No longer will those who purchased insurance worry that it will run out because of caps on annual or lifetime limits.

We have a chance to create a marketplace that will make insurance options easier to understand by providing apples-to-apples comparison shopping and by making prices more transparent, providing consumers more choice and competition.

To implement these pieces of the law, Missouri will have to make a decision. Do we want to create this marketplace, called a Health Insurance Exchange, by enacting legislation at the state level, or have the HHS do it for Missouri? This decision has to be made by Nov. 16, 2012. Before that date, a ballot initiative will be before the voters asking whether or not the legislature must be involved in the creation of an exchange. Either way, time is running out.

There are a huge number of things that need to get done in a short period of time, not the least of which is creating a modern database management system that can interface with the new marketplace and meet all its requirements. Missouri does not have the technical capability to do that work with its current system and the funding provided to create that system is locked up in what can best be described as political limbo.

The other great question the ruling puts in front of Missouri is the expansion of Medicaid. The Medicaid expansion is a significant part of the reform and accounts for almost half of the number of people estimated to gain coverage. The Supreme Court ruling leaves the decision to expand Medicaid to the states. The expansion would cover both parents and childless adults up to 133 percent of the federal poverty level (FPL). Right now Missouri covers kids to that level but only covers their parents up to 20 percent of FPL and does not cover any childless adults.

The expansion of coverage in Missouri is expected to be 255,000 newly covered people. The total cost of these covered lives would be paid for in the first three years (2014-2016) by the federal government and after that, a cost sharing arrangement would be phased in arriving at a fixed cost share of 90 percent federal dollars and 10 percent coming from the state by the year 2020 and beyond.

So how much money are we talking about? In the first five years, Missouri would receive $11.3 billion from the federal government starting in 2014 and the state starting in 2017 would be required to put up $375 million, according to numbers provided by the Missouri Department of Social Services. That money would go a long way toward helping our community pay for the care of everybody in Missouri.